Objective: To assess the efficacy of a combined botulinum neurotoxin (BoNT) treatment with biofeedback exercises in a single Parkinson Disease (PD) patient with Pisa Syndrome (PS).

Background: PS is a postural abnormalitiy in (PD) , usually characterized by a lateral flexion of the trunk at least 10°, typically more evident in standing posture but that can be relieved by lying position [1]. Postural abnormalities can be improved by a combination of BoNT injections in trunk muscles and rehabilitation program based on motor learning [2].

Method: A 74 years old woman was evaluated longitudinally over 3 months: before BoNT (T0), after 4 weeks (T1) and 12 weeks (T2), follow up. A kinematic analysis with a 9-camera optoelectronic system (BTS Engineering, Milan, Italy) using a whole body protocol LAMB during standing and walking was performed at each time point. At T0 pt underwent a BoNT injection into the ileocostalis and abdominal external obliquus muscles and a tailored rehabilitation program (45 minutes, 20 sessions, 5 times a week) using specific devices in order to control position and movements of the trunk and of the pelvis in frontal plane, giving different movement learning strategies. As measures of clinical outcome were used variations of Center of Pressure (CoP) position during standing and omolateral trunk deviation during walking at T1 and T2.

Results: Before BonT and Rehabilitation program the patient showed right shift of CoP and right trunk deviation during walking and a reduction of the hip adduction moment (HAM). After the combined treatment DF showed nearly balanced CoP position during standing and reduced trunk deviation even during walking, maintained at the follow up. Moreover, HAM was positively increased.

Conclusion: An improvement of trunk alignment, determining a more balanced CoP during standing and walking, was quantitatively and longitudinally assessed after the combined treatment. The results were maintained at follow-up when BoNT effect was wearing.This clinical case suggests the importance of the proposed combined treatment; larger studies are needed to confirm these data.

References: [1] Doherty KM et Al. Lancet Neurol 2011; 10: 538–49 [2] Tassorelli et al. Parkinsonism Relat Disord. 2014 Nov;20(11):1140-4.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-a-combined-treatment-with-botulinum-toxin-and-biofeedback-exercises-in-pisa-syndrome/